MEDICARE: MR. MICHAEL JOSEPH TRAVAGLIANTE ATC, LPTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	PTA02598	OH
2	2255A2300X	Athletic Trainer	AT000167	OH

General Provider Information

NPI Number	:	1194706119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL JOSEPH TRAVAGLIANTE ATC, LPTA

Provider Business Mailing Address
First Line	:	1366 SUNVIEW RD
Second Line	:
City	:	LYNDHURST
State	:	OH
Zip	:	44124-1344
Country	:	US
Telephone Number	:	440-442-7841
Fax Number	:	216-595-2879

Provider Business Practice Location Address
First Line	:	4480 RICHMOND RD
Second Line	:
City	:	WARRENSVILLE HEIGHTS
State	:	OH
Zip	:	44128-5777
Country	:	US
Telephone Number	:	216-595-2880
Fax Number	:	216-595-2879

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	09/11/2025

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